Kevin Patrick Banks MD, Presenter: Nothing to Disclose

Liem Thanh Mansfield MD, Abstract Co-Author: Nothing to Disclose

1.  Understanding the anatomy of pelvic lymph nodes and the common and uncommon lymphatic pathways of metastasis will help detect disease spread 2.  The common pathways of lymphatic spread are the superficial inguinal, pelvic, and paraaortic pathways 3.  The uncommon pathways of lymphatic spread are along the gonadal vessels, mesentery, mesocolon, and inferior phrenic node 4.  Knowing the pathways of nodal metastasis may help to detect the source of an occult primary malignancy 5.  Understanding the strengths and limitations of PET-CT in the N-staging/restaging of pelvic aides in the optimal utilization of these exams and their interpretation.  

1. Anatomy of major pelvic lymph nodes     a. Inguinal     b. External iliac     c. Internal iliac     d. Common iliac     e. Obturator     f. Presacral     g. Paraaortic 2. Common pathways      a. Superficial inguinal: vulva, penis, lower vagina, lower rectum, anus     b. Pelvic         i. Anterior: anterior bladder         ii. Lateral: bladder, prostate, upper vagina, cervix, uterus, ovary, rectum         iii. Internal iliac: most pelvic organs         iv. Presacral: prostate, cervix, rectum     c. Paraaortic: ovary, testis 3. Uncommon pathways                    a. Along gonadal vessels: ovary, testis     b. Mesenteric pathway: ovary, testis, prostate     c. Mesocolic pathway: prostate, ovary     d. Inferior phrenic: ovary  

http://abstract.rsna.org/uploads/2014/14013554/14013554_3qxi.pdf

Banks, K, Mansfield, L, Follow the Yellow Brick Road: PET-CT Demonstration of Pathways of Lymphatic Spread of Malignant Pelvis Neoplasms.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14013554.html